Notification and Communication Technology: An Observational Study of Call Light Systems in Nursing Homes

Abstract

Background and Objectives: The call light system is one of the major communication technologies that links the nursing home staff to the needs of the residents. By providing residents with the ability to request assistance, the system becomes an indispensable resource for patient-focused healthcare. However, there is little known about how the call light systems are being used in nursing homes and how the system contributes to the safety and the quality of care for seniors. Therefore, the aims of this study are to understand the nursing home staff experience while using the call light systems and to uncover the usability issues associated with the implemented systems. Method: A mix of 150 hours of hypothetic-deductive (unstructured) and 90 hours of standard-procedure (structured) observational study were conducted in four different nursing homes. The data collected includes insights into the nursing homes work system and the process of locating and responding to call lights. Results: The data shows that the highest alarm rate is before and after meal times. The nursing staff exceeded the allotted time set by administration 50% of the time. Additionally, the staff canceled 10% of the call lights and did not immediately assist residents due to high workloads. Further, the staff forgot to come back to assist residents over 3% of the time. Usability issues such as broken parts, lack of feedback, lack of prioritization, and low/no discriminability are contributing to the long response time. More than 8% of the time, residents notified the staff about call lights after they waited for a long time, as these residents were left unattended. Conclusion: Nursing homes that are still using old call light systems risk the continuation of usability issues that can affect performance of the staff and contribute to a decline in staff and resident outcomes. While the healthcare industry has been at the forefront of technological advancements and implementation, it is important to recognize the influence of technology in the quality of service delivery for the elderly population in nursing homes and to the nursing homes staff working conditions.

Perspectives of Nursing Homes Staff on the Nature of Residents-Initiated Call Lights

“…A survey instrument was designed based on expert opinions and studies created with similar research goals (Ali & Li, 2019, 2020Ali et al, 2017;Deitrick et al, 2006;Li & Ali, 2015;Meade et al, 2006;Tzeng, 2011a;Van Handel & Krug, 1994). These insights were used to draft a preliminary list of items that were important to measure, such as perceived mental and physical workload, noise, the process of responding and location call lights, unit layout effect, perceived nature of call lights, and overall satisfaction with the call light system.…”

“…There are many studies showing the impact of technology on patients, but few that show a nurse's perspective (Deitrick et al, 2006;Tzeng, 2011a). Research suggests that only assessing residents' satisfaction with the call light system limits the way developers understand the usability of their technology (Ali & Li, 2019, 2020Ali, Li, & Wong, 2017). As a result, ideas and solutions addressing the delays in call light responses have involved improving usability from a patientcentered and largely administrative perspective.…”

“…Nursing homes report seeing longer response times despite the improvements made to call light systems (Ali & Li, 2019;Kalisch et al, 2013;Lasiter, 2014;Meade et al, 2006). These long response times might be associated with usability issues and challenges the staff faces with the current call light systems (Ali & Li, 2019, 2020Kripalani et al, 2014;Tzeng & Yin, 2009).…”